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1609426071 NPI number — RYAN FRED ALEX ZUBER PMHNP-BC

NPI Number: 1609426071
Health Care Provider/Practitioner: RYAN FRED ALEX ZUBER PMHNP-BC

Information about “1609426071” NPI (RYAN FRED ALEX ZUBER PMHNP-BC) exists in 1609426071 in HTML format HTML  |  1609426071 in plain Text format TXT  |  1609426071 in PDF (Portable Document Format) PDF  |  1609426071 in an XML format XML  formats.

NPI Number : 1609426071 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609426071",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ZUBER",
    "FirstName": "RYAN",
    "MiddleName": "FRED ALEX",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "PMHNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "814 ASCHAM CT.",
    "SecondLineMailingAddress": "HENDERSON ROAD",
    "MailingAddressCityName": "PEARL",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39208-9361",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "601-966-1977",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1500 E WOODROW WILSON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSON",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39216-5116",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-362-4471",
    "PracticeLocationAddressFaxNumber": "601-368-3904",
    "EnumerationDate": "09/17/2019",
    "LastUpdateDate": "09/06/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": "903437",
        "LicenseNumberStateCode": "MS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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